Perceptions of Factors Associated With Sustainability of Health Care Innovation Centers.

Importance: Innovation centers in US health care systems are increasingly common but variably successful and sustainable. Few studies have examined how and why some centers achieve sustainable success but others do not. Objective: To explore whether and how innovation centers in US health care systems are able to successfully sustain themselves over multiple years. Design, Setting, and Participants: In this qualitative study, semistructured, qualitative interviews of leaders at 9 innovation centers across the US were conducted from January 1, 2019, to December 31, 2020. Data analysis was conducted from December 2020 to April 2021 using qualitative methods and a deductive framework based on the Consolidated Framework for Implementation Research. Centers were identified through purposeful sampling. The 9 study centers had a mean age of 6 years (range, 2-15 years); most were affiliated with an academic teaching hospital and half with a medical school. Two were wholly separate from the health care system. Two-thirds had fewer than 10 full-time staff members. Exposures: All interviewees were staff of a US-based innovation center. This study did not evaluate particular interventions or innovations. Main Outcomes and Measures: Perceptions of and views on factors associated with the success and sustainability of innovation centers. Results: Staff interviewed at 9 innovation centers across the US described 3 key activities that appeared to be associated with long-term sustainability: facilitating innovation projects that were valued for quality improvement and cost avoidance, not just return on investment; acting as networking nodes for their institutions; and upskilling staff. These activities were associated with improved institutional culture. Two structural characteristics underpinned successful centers: finding an effective balance between being "internal" and being "external" to the organization and providing practical support and skills otherwise lacking within the wider institution. Conclusions and Relevance: This qualitative study of 9 innovation centers explored how centers sustained themselves within US health care institutions and showed that success was often associated with interpersonal relationships and cultural benefits. Independent financial sustainability was not always essential to longevity; systems also valued how centers could create cultures of innovation and upskill staff.

Using Rapid Randomized Trials to Improve Health Care Systems.

Rapid randomized controlled trials have been surprisingly rare in health care quality improvement (QI) and systems interventions. Applying clinical trials methodology QI work brings two distinct fields together, applying the robustness of randomized controlled trials (RCTs) to the practical, operational learnings of the well-established QI field. Rapid trials also add a third element-speed-that enables health care systems to rapidly test multiple variations of an intervention in much the same way that A/B testing is done in the technology sector. When performed well, these rapid trials free researchers and health care systems from the requirement to be correct the first time (because it is low cost and quick to try something else) while offering a standard of evidence often absent in QI. Here we outline the historical underpinnings of this approach, provide guidance about how best to implement it, and describe lessons learned from running more than 20 randomized projects in the NYU Langone Health system.

Chinese Americans' Use of Patient Portal Systems: Scoping Review.

BACKGROUND: Electronic patient portals are increasingly used in health care systems as communication and information-sharing tools and show promise in addressing health care access, quality, and outcomes. However, limited research exists on portal use patterns and practices among diverse patient populations, resulting in the lack of culturally and contextually tailored portal systems for these patients. OBJECTIVE: This study aimed to summarize existing evidence on the access and use patterns, barriers, and facilitators of patient portals among Chinese Americans, who represent a growing patient population in the United States with unique health care and health technology needs. METHODS: The authors conducted a literature search using the PRISMA Protocol for Scoping Reviews (Preferred Reporting Items for Systematic Reviews and Meta-Analyses-ScR) for extracting articles published in major databases (MEDLINE, Embase, and PsycINFO) on patient portals and Chinese Americans. Authors independently reviewed the papers during initial screening and full-text review. The studies were analyzed and coded for the study method type, sample population, and main outcomes of interest. RESULTS: In total, 17 articles were selected for inclusion in the review. The included articles were heterogenous and varied in their study aims, methodologies, sample populations, and outcomes. Major findings identified from the articles include variable patterns of portal access and use among Chinese Americans compared to other racial or ethnic groups, with limited evidence on the specific barriers and facilitators for this group; a preference for cross-sectional quantitative tools such as patient surveys and electronic health record-based data over qualitative or other methodologies; and a pattern of aggregating Chinese American-related data into a larger Asian or Asian American designation. CONCLUSIONS: There is limited research evaluating the use patterns, experiences, and needs of Chinese Americans who access and use patient portal systems. Existing research is heterogeneous, largely cross-sectional, and does not disaggregate Chinese Americans from larger Asian demographics. Future research should be devoted to the specific portal use patterns, preferences, and needs of Chinese Americans to help ensure contextually appropriate and acceptable design and implementation of these digital health tools.